Thursday 1 - infectious disease

Question 1

Big three symptoms of CNS infections?

Answer 1

Fever, headache, altered mental state.

Question 2

Some organisms that can cause memengitis, bacterial and viral.

Most common bacterial sources by age? (young and adult)

Answer 2

Non-viral (serious) - most common - Neisseria meningitidis (most common in younger people), Streptococcus pneumonia (~75% in adults), haemophilus influenza.

less common - Rickettsia, Mycoplasma, Listeria monocytogenes

viral: Herpes, enterovirus, arbovirus, rabies

Question 3

Some organisms that can cause encephalitis.

Answer 3

Fungal - more chronic

Herpes

Question 4

5 non-infecitous causes of “fever, headache, altered mental state”

Answer 4

Subarachnoid hemorhage, inflammatory disease (lupus), Neoplasia, metabolic (ammonia build up), drug (NSAID)

Question 5

3 Types of CNS infections (Broad)

Answer 5

meningitis, encephalitis, abscess

Question 6

Where is meningitis in the brain

Answer 6

subarachnoid space

Question 7

Where is encephalitis in the brain

Answer 7

diffuse parenchyma

Question 8

Encephalopathy

Answer 8

refers to diffuse cerebral dysfunction without inflammation usually due to toxin, or metabolic product

Question 9

What example of meningitis in class was transmitted via the respiratory system?

Answer 9

Neisseria meningitidis

Question 10

Disease from class the had a 25% mortality rate and had a “major” outbreak in 2014

Answer 10

Listeria monocytogenes meningitis

Question 11

Best empiric antibiotic for meningitis, how much greater do you want to concentration than the MIC in order for it to be bacteriocidal?

Answer 11

3rd gen cephalosporin (+ Ampicillin?)

10 times the MIC

Question 12

What is often included with the antibiotic in encephalitis in order to decrease inflam?

Answer 12

dexamethasone

Question 13

mech of Ceftriaxone (3rd gen cephalosporin)

Ways that the bacteria can become resistant to it?

Answer 13

inhibition of transpeptidation of peptidoglycan

Resistance can occur if the bacteria inactivates the drug via beta-lactamases

Question 14

General properties of Listeria monocytogenes

3 symptoms from listeria meningitis, and one common menigitis symptom not seen in the case in class

Answer 14

Gram +
Rod

Fever, headache, diarrhea

No nuchal rigidity

Question 15

What is the definitive therapy for Listeria monocytogenes?

Answer 15

Ampicilin + Gentamicin

genta - aminoglycoside -(ribozyme inhibitor)

Question 16

4 main (non culture) things you look for in lumbar puncture for suspect meningitis.

Which is prominent in which type of meningitis?

Answer 16

WBC count - will be high
WBC diff. - high PMN if bacterial, high lymphocyte if viral, fungal, or tuberculous
protein - will be high
glucose - will be low (especially in bacterial infection, tuberculous infection)

Question 17

Main symptoms in viral meningitis

Answer 17

Fever, headache, photophobia

Stiff neck less common with viral meningitis

Question 18

Most common type of virus seen in Meningitis

What type of virus is it? RNA or DNA?

Answer 18

enterovirus/picornavirus (coxsackie, ECHO, polio)

RNA virus

Question 19

Major endotoxin of Neisseria meningitides. what does it mimic in humans?

What is one clinical sign about this type of meningitis that is not as often seen in other bactrerial types?

Answer 19

LOS (lipooligosacchride)

mimics sphingolipids in the brain

purpuritic skin rash

Question 20

Things about hemophilus influenza type b with respect to meningitis

occurs in:
infection can be followed by this debilitation:
type b reffers to:

Answer 20

In unvaccinated kids

hearing loss

B capsular polysaccharide - cap around the bacteria helps it into the brain

Question 21

TORCH infections

Who are they dangerous to?
two organisms that cause them

Answer 21

serious fetal consequences

Meningitis: Group B strep, E. coli

Question 22

Group B streptococcus General

Answer 22

GI and urinary tract flora
vertical transmission to infact
more common in african americans
pregnant women screened with 25% as carriers and given penicillin G and prophylactic

Question 23

3 organisms that you are worried about kids getting infected with (meningitis) but not usually adults

Answer 23

GBS (group b strep)
E. Coli
Listeria

Question 24

Chronic meningitis organisms

Answer 24

spirochetes, mycobacterium tuberculosis, fungi (cryptococcus, coccidioides, candida)

Question 25

Amphotericin B

mech
spectrum
distribution in brain
averse

Answer 25

Binds ergosterol, making holes in fungal membrane

broad spectrum

Liposomal, crosses BBB

Nephrotoxic because it binds cholesterol, amphoTERRIBLE.

Question 26

Flucytosine

mech
spectrum

Answer 26

converts to 5-FU in fungi

spec is narrow - yeast

Question 27

Azoles

mech
spectrum

Answer 27

binds fungal p-450

systemic mycoses